Health Care Regulatory Solutions
Doing business with the government is nothing new for many health plans. But even for the most government-oriented insurers, the game has changed. Medicaid is expanding. Medicare’s population is growing. And health insurance exchanges are live. More government money in the system and compliance with the Affordable Care Act (ACA) mean more government influence as well—and as the government changes its purchase expectations and interactions with plans, plans will likely change not just the amount of business done, but also how it’s done. With our professionals and your team members working side by side, your organization can plan long-term moves to help navigate this changes.
Your new biggest customer
Are you equipped for a new era in collaboration, cost control, and compliance?
Medicare and Medicaid are expanding and exchanges are brand-new. All three models mean your growth opportunities are funded by the public sector—and more of the rules that accompany that funding. Risk selection, plan design, and actuarial calculus may not be the focal points of profit anymore. Instead, plans will need to do a better job of improving quality, engaging customers, and controlling costs by reinventing relationships with providers and guiding individual members to make better health care choices.
And while the Affordable Care Act (ACA) isn’t the first major regulatory change that plans have had to adapt to, the changes happening now are more complex and the intensity they bring may be permanent. In this environment, plans will need to stock up on vital skills, be sure their platforms are ready and perhaps even change their internal structures.
What’s your plan to expand and remain profitable as you grow in government-funded programs? Do you have the tools to support the change as you head into new territory? How will your business model need to adapt to accurately support ACA compliance?
Government programs: Meet your new biggest customer
There’s more to the government’s new influence than the simple law of supply and demand applied to a huge and growing customer base. Reform brings plenty of explicit new rules about rating, breadth of coverage, actuarial models, and medical loss ratios. More government influence can mean less room to maneuver in plan design, ratings, and risk selection. The challenge for you, as a health plan, is to find other ways to differentiate yourself.
Find out more about meeting these challenges. Download the report.
Meeting intensity with ingenuity
Compliance with the Affordable Care Act (ACA) may involve more than changes to offerings or terms. It may change your business model.
Read more about health plans compliance. Download the report.